自体血液回输对髋关节置换术围术期凝血功能的影响

Effect of autotransfusion on perioperative coagulation function in patients undergoing hip replacement

目的探讨自体血液回输在老年患者全髋关节置换术中对凝血功能的影响,为围术期选择合理的血液制品提供依据。方法选取2016年1-12月在该院择期行全髋关节置换手术的老年患者40例,美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级,采用随机数字表法分为观察组和对照组,观察组为自体血液回输组,对照组为异体输血组,每组20例。观察组术中应用血细胞回输仪进行血液收集、回输,两组均于输血前(T0)、输血后1h(T1)、关节置换后2h(T2)3个时点采集静脉血,采用血栓弹力图(TEG)测定纤维蛋白原形成时间(R)、血凝块生成时间(K)、最大振幅(MA)、凝血综合指数(CI)水平。结果观察组在T2时间,与T0相比,K延长(P<0.05)。对照组完成关节置换后2h较术前比较,TEG各指标差异无统计学意义(P>0.05);观察组在T2时间点K比对照组延长(P<0.05),但观察组在T1、T2时刻测得的TEG参数均在正常范围内。结论患者术前、术中及术后血液呈不同程度高凝状态,采用自体血液回输虽然对凝血功能有一定影响,但在正常范围内,可减轻患者高凝状态。

Objective To assess the perioperative coagulation function of autotransfusion in patients undergoing hip replacement.Methods Forty gerontal patients with hip replacement which ASA class asⅡ-Ⅲin our nosipital,were randomly divided into two groups(n=20 each):the autotransfusion group(the experimental group)and the allogeneic transfusion group(the control group).Blood collection and transfusion were performed by hematopoiesis apparatus in the experimental group.Blood samples were collected for coagulation function test at the following time points:before transfusion(T0),1 hafter transfusion(T1),2 hafter hip replacement(T2).Thromboelaslography(TEG)was used to measure the level of fibrinogen formation time(R),blood clot formation time(K),maximum amplitude(MA)and coagulation composite index(CI)at T0,T1 and T2.Results In the experimental group,the K was prolonged at T2,with significant difference compared to T0(P<0.05).In the control group,the TEG paramaters at T2 have no statistics significance compared to T0(P>0.05).The K at T2 in the experimental group was significantly prolonged compared with the control group(P<0.05).The TEG parameters measured in the experimental group at T1 and T2 were all in the normal range.Conclusion Preoperative,intraoperative and postoperative blood of the patients showed different degrees of hypercoagulation.Autotransfusion can prolong the K,but the K was still in a normal range which alleviated the hypercoagulation in patients undergoing hip replacement.